In the United States, colorectal cancer (CRC) is the second leading cause of cancer mortality. A growing body of evidence indicates that CRC deaths could be greatly reduced through appropriate screening. However, CRC screening continues to be underutilized, particularly by racial/ethnic minorities. According to ethnicity-specific data from California, CRC ranked among the top three most common cancers in both men and women from several Asian ethnic groups. Moreover, foreign-born Asian Americans and Pacific Islanders presented at a later stage of disease than U.S.-born individuals. A recent study showed that Asian men were significantly less likely to receive a sigmoidoscopy compared with White men. Two convenience surveys of the largest U.S. Asian subgroup, Chinese Americans, supported this finding by revealing low CRC screening rates: 11% and 16% reported Fecal Occult Blood Tests (FOBT) during the past year; 22% reported FOBT during the past year and sigmoidoscopy during the past 5 years; and 30% reported sigmoidoscopy in the past 5 years.

The Program

The Colorectal Cancer Screening In Chinese Americans Project is a clinic-based educational program aimed at promoting FOBT screening among lower-income and less-acculturated Chinese Americans. Knowledge and barriers are addressed through CRC screening education by a bicultural Chinese American health educator who is trilingual (English, Cantonese, and Mandarin). Educational materials include:

A motivational video on CRC screening, produced in Cantonese and dubbed into Mandarin

A bilingual CRC motivational pamphlet

A bilingual CRC informational pamphlet from the Federation of Chinese American and Canadian Medical Societies

An FOBT kit with instructions in Chinese and English

Community Preventive Services Task Force Finding

This program uses an intervention approach recommended by the Community Preventive Services Task Force: small media interventions (Colorectal Cancer Screening).

Time Required

The educational program is given during the patients' clinic visits and is tailored to the needs of the patient. Therefore, the time required may vary. For example, systematically addressing expressed barriers to CRC screening through personal health education may take more time than just giving the pamphlets to a patient. The video is just over 15 minutes long.

Intended Audience

The intended audience for this intervention is lower-income, less-acculturated Chinese immigrant men and women, aged 50-78 years.

Suitable Settings

This intervention is suitable for community clinics that provide comprehensive primary care services, with access to a bilingual health educator for patients who do not speak English.

The Colorectal Cancer Screening Among Chinese Americans project was evaluated by using a randomized controlled trial to assess FOBT screening adherence. Participants were recruited from a community clinic that provides comprehensive primary care to a predominantly Asian population in the metropolitan area of Seattle, Washington. Patients were randomized into either a treatment group that received clinic-based education, or a control group that received usual care. Usual care consisted chiefly of FOBT ordered by primary care providers, with medical assistants implementing all orders and instructing patients to return completed FOBT cards to the clinic laboratory for processing and documentation of results on a laboratory form. A total of 210 eligible participants had a scheduled appointment during the 14-month study period. Patients were categorized as age 50-64 (54.3%) and age 65 or older (45.7%), with 62.9% being female and 37.1% male.

The outcome measure, FOBT screening within 6 months of random assignment to one of the two groups, was based on chart audit. Patients with three FOBT cards documented in their medical records were considered as having completed FOBT screening.

Key Findings

Among the intervention patients, 69.5% received FOBT screening, compared with 27.6% of control patients: OR=5.98 (95% CI=3.29, 10.85).